Bronchiolitis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Bronchiolitis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Bronchiolitis]]
{{CMG}}{{AE}}{{AEL}}
{{CMG}}{{AE}}{{AEL}}


==Overview==
==Overview==
Bronchiolitis must be differentiated from other [[respiratory]] and [[cardiac]] diseases that are presented with similar clinical manifestations. Based on [[cough]] and [[dyspnea]], bronchiolitis is differentiated from [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse idiopathic neuroendocrine cell hyperplasia, [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].
[[Bronchiolitis]] must be differentiated from other [[respiratory]] and [[cardiac]] diseases that present with similar clinical manifestations of [[cough]] and [[dyspnea]]. Bronchiolitis should be differentiated from [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], [[diffuse]] [[idiopathic]] [[neuroendocrine]] [[Hyperplasia|cell hyperplasia]], [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]], and [[Interstitial Pneumonia|Harman-Rich syndrome]].


==Differentiating bronchiolitis from other diseases==
==Differentiating bronchiolitis from other diseases==
Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like [[cough]] and [[dyspnea]].<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref><ref name="pmid26169577">{{cite journal| author=Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH et al.| title=A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough. | journal=Pharmacogenomics J | year= 2016 | volume= 16 | issue= 3 | pages= 231-7 | pmid=26169577 | doi=10.1038/tpj.2015.51 | pmc=4713364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26169577 }} </ref><ref name="pmid28454456">{{cite journal| author=Jiang S, Li J, Zeng Q, Liang J| title=Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report. | journal=Oncol Lett | year= 2017 | volume= 13 | issue= 4 | pages= 2713-2716 | pmid=28454456 | doi=10.3892/ol.2017.5775 | pmc=5403205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28454456  }} </ref><ref name="pmid28452705">{{cite journal| author=Lin L, Chen Z, Cao Y, Sun G| title=Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. | journal=Am J Rhinol Allergy | year= 2017 | volume= 31 | issue= 2 | pages= 96-104 | pmid=28452705 | doi=10.2500/ajra.2017.31.4418 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28452705 }} </ref>
[[Bronchiolitis]] must be differentiated from other respiratory and cardiac diseases that can cause the similar clinical manifestations like [[cough]] and [[dyspnea]]. The differentials include the follwoing:<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="pmid28452705">{{cite journal| author=Lin L, Chen Z, Cao Y, Sun G| title=Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. | journal=Am J Rhinol Allergy | year= 2017 | volume= 31 | issue= 2 | pages= 96-104 | pmid=28452705 | doi=10.2500/ajra.2017.31.4418 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28452705 }} </ref><ref name="pmid28454456">{{cite journal| author=Jiang S, Li J, Zeng Q, Liang J| title=Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report. | journal=Oncol Lett | year= 2017 | volume= 13 | issue= 4 | pages= 2713-2716 | pmid=28454456 | doi=10.3892/ol.2017.5775 | pmc=5403205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28454456  }} </ref><ref name="pmid26169577">{{cite journal| author=Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH et al.| title=A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough. | journal=Pharmacogenomics J | year= 2016 | volume= 16 | issue= 3 | pages= 231-7 | pmid=26169577 | doi=10.1038/tpj.2015.51 | pmc=4713364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26169577 }} </ref><ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>
 
===Differentiating bronchiolitis based on cough and dysnea===
Based on [[cough]] and [[dyspnea]], bronchiolitis is differentiated from [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse idiopathic neuroendocrine cell hyperplasia, [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].


{| class="wikitable"
{| class="wikitable"
! rowspan="2" |Diseases
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! colspan="2" |Symptoms
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
!
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs
! colspan="4" |Signs
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagosis
! colspan="2" |Diagosis
|-
|-
!Fever  
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever  
!Cough
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Chest pain
!Chest pain
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cough
!Wheezes
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Wheeze
!Crackles
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Crackles
!Edema
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Tachycardia
!Tachycardia
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab tests
!Lab tests
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging  
!Imaging  
|-
|-
|[[Bronchiolitis]]
|[[Bronchiolitis]]
| +/-
| +/-
|<nowiki>-</nowiki>
|Dry
|Dry
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| +
| +
| -
| +/-
| +/-
|
|
* Viral tests like [[ELISA]] and [[immunoassays]] may be done in case of [[RSV]] infection.
* [[ELISA]] and [[immunoassays]] may be done in case of [[RSV]] [[infection]]
* [[Pulmonary function test]] is performed to exclude other [[lung diseases]].<ref name="pmid18339530">{{cite journal| author=Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM et al.| title=An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. | journal=Respir Med | year= 2008 | volume= 102 | issue= 6 | pages= 825-30 | pmid=18339530 | doi=10.1016/j.rmed.2008.01.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18339530  }} </ref>
* [[Pulmonary function test]] to exclude other [[lung diseases]]<ref name="pmid18339530">{{cite journal| author=Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM et al.| title=An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. | journal=Respir Med | year= 2008 | volume= 102 | issue= 6 | pages= 825-30 | pmid=18339530 | doi=10.1016/j.rmed.2008.01.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18339530  }} </ref>
|
|
* In CT scan, intense bronchiolar mural [[inflammation]] of cellular bronchiolitis results in centrilobular [[nodules]] that are usually associated with the tree-in-bud pattern and [[bronchial]] wall thickening
* [[CT scan]] shows:
** Intense [[Bronchiolar epithelium|bronchiolar]] mural [[inflammation]]
** [[Bronchial]] wall thickening
** Centrilobular [[nodules]] with tree-in-bud pattern
|-
|-
|[[Asthma]]
|[[Asthma]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| -
|Dry/Productive
|Dry/Productive
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
| + [[Pulmonary edema]]
| -
| -
|
|
* Lab tests are performed to exclude other diseases.
* [[Pulmonary function tests]]        ([[PFTs|PFT]]) to exclude other [[Disease|diseases]]
* Serum examination shows elevated level of esoinophils due to [[allergy]].    
 
* Serum examination shows elevated level of [[Eosinophil|eosinophils]] due to [[allergy]]   
|
|
* CT scan shows dilated [[bronchi]], bronchial wall thickening and air trapping.
* [[CT scan]] shows:
** Dilated [[bronchi]]
** [[Bronchial]] wall thickening
** Air trapping
|-
|-
|[[COPD]]
|[[Chronic obstructive pulmonary disease]]            ([[COPD]])
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Productive
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|[[Productive cough|Productive]]
| +
| +
| +
| +
| +
| +
| +
|
|
* Spirometry: FEV1/FVC < 70%
* [[Spirometry]]: [[FEV1/FVC ratio|FEV1/FVC]] < 70%
* Atrial blood gases: [[hypoxemia]] and [[hypercapnia]]
 
* Arterial blood gases:
** [[Hypoxemia]]
** [[Hypercapnia]]
 
* [[Sputum culture]]   
* [[Sputum culture]]   
|
|
* EKG may show [[P pulmonale]], [[right ventricular hypertrophy]] and low QRS.<ref name="pmid23653989">{{cite journal| author=Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M| title=Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. | journal=Med Pregl | year= 2013 | volume= 66 | issue= 3-4 | pages= 126-9 | pmid=23653989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23653989  }} </ref>  
* EKG may show:
* CT scan is more sensitive in diagnosing COPD than X ray.  
** [[P pulmonale]]  
** [[Right ventricular hypertrophy]]  
** Narrow [[QRS]]<ref name="pmid23653989">{{cite journal| author=Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M| title=Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. | journal=Med Pregl | year= 2013 | volume= 66 | issue= 3-4 | pages= 126-9 | pmid=23653989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23653989  }} </ref>  
* [[Computed tomography|CT scan]] is more [[Sensitivity (test)|sensitive]] in diagnosing [[Chronic obstructive pulmonary disease|COPD]] than X-ray   
|-
|-
|[[Bacterial pneumonia]]  
|[[Bacterial pneumonia]]  
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Productive
| +
| +
|[[Productive cough|Productive]]
| +
| +
| +
| +
| -
| +/-
| +/-
|
|
* Diagnosis depends mainly on the presentation and physical examination.
* Diagnosis depends on presentation and [[physical examination]]
* Laboratory tests: [[arterial blood gases]] may show [[hypoxia]] and [[acidosis]].
* Laboratory tests
* [[Sputum culture]].
** [[Arterial blood gases]] may show [[hypoxia]] and [[acidosis]]  
** [[Sputum culture]]
|
|
* X ray is performed to detect [[pleural effusion]] and inflitrates within the [[lungs]].
* [[Chest X-ray]] may show:
* CT scan shows [[Consolidation (medicine)|consolidation]] and ground glass appearance.
** [[Pleural effusion]]  
** Inflitrates within the [[lungs]]
* [[Computed tomography|CT scan]] may show:
** [[Consolidation (medicine)|Consolidation]]  
** [[Ground glass opacification on CT|Ground glass appearance]]
|-
|-
|[[Pulmonary embolism]]
|[[Pulmonary embolism]] ([[Pulmonary embolism|PE]])
| +/-
| +/-
| +
|Bloody
|Bloody
| +
| +
| +
| +
| +
| +
| +
| +
|
|
* [[D-dimer]] level test is performed to rule out other diseases like [[DVT]].
* Arterial blood gases may show:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref>
* Routine blood tests are non specific.
* [[Hypercoagulability]] tests are performed in patients with unprovoked [[venous thrombosis]] at an early age (< 40 years) and family history of [[VTE]] syndromes.
*Arterial blood gases show the following:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref>  
**[[Hypoxemia]]
**[[Hypoxemia]]
**[[Hypocapnia]]
**[[Hypocapnia]]
**[[Respiratory alkalosis]]
**[[Respiratory alkalosis]]
**Increased alveolar-arterial gradient  
**Increased alveolar-arterial gradient  
*[[D-dimer diagnostic role in thromboembolism|D-dimer assay]] may show elevated levels of [[D-dimers]]
* [[Hypercoagulability]] tests for patients with:
** Unprovoked [[venous thrombosis]] at an early age (< 40 years)
** [[Family history]] of [[VTE]] syndromes
*Routine [[blood]] tests are non specific
|
|
* CT [[pulmonary angiography]] is the gold standard imaging to diagnose the pulmonary embolism. It shows the following:
* CT [[pulmonary angiography]] is the [[Gold standard (test)|gold standard]] imaging to diagnose [[pulmonary embolism]]. CT may show:
**Acute:Centrally located [[thrombus]] or occluding the vessel.
**Acute: Centrally located [[thrombus]] occluding the vessel
**Chronic:Eccentric changes in the [[vessel wall]], recanalization in the thrombous and arterial web.
**Chronic: Eccentric changes in the [[vessel wall]], recanalization in the thrombous and arterial web  
* EKG is not specific or sensitive in PE diagnosis but it may show [[T wave inversion]], [[P pulmonale]] and [[sinus tachycardia]].
* [[EKG]] is neither [[Specificity (tests)|specific]] nor [[Sensitivity (tests)|sensitive]] in diagnosing [[Pulmonary embolism|PE]] but it may show:
* Chest X ray is performed to exclude other differentials.
** [[T wave inversion]]  
** [[P pulmonale]]  
** [[Sinus tachycardia]]  
* [[Chest X-ray]] to exclude other differentials  
|-
|-
|Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia<ref name="pmid21471097">{{cite journal| author=Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F| title=Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview. | journal=Am J Respir Crit Care Med | year= 2011 | volume= 184 | issue= 1 | pages= 8-16 | pmid=21471097 | doi=10.1164/rccm.201010-1685PP | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21471097  }} </ref>
|[[Diffuse]] [[idiopathic]] [[neuroendocrine]] [[Hyperplasia|cell hyperplasia]]<ref name="pmid21471097">{{cite journal| author=Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F| title=Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview. | journal=Am J Respir Crit Care Med | year= 2011 | volume= 184 | issue= 1 | pages= 8-16 | pmid=21471097 | doi=10.1164/rccm.201010-1685PP | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21471097  }} </ref>
| -
| -
| -
|Dry
|Dry
| -
| +
| +
| -
| -
| -
| -
| -
|
|
* Pulmonary function test shows obstructive lung disease
* [[Pulmonary function test]] shows obstructive lung disease (FEV1/FVC less than 0.7)
|
|
* CT scan shows multiple [[nodules]] , ground glass appearance and bronchiectasis.
* [[Computed tomography|CT scan]] may show:
** Multiple [[nodules]]
** [[Ground glass opacification on CT|Ground glass]] appearance
** [[Bronchiectasis]]
|-
|-
|[[Tuberculosis]]  
|[[Tuberculosis]]  
| +
| +
| +
|Bloody  
|Bloody  
| +
| -
| -
| -
| -
| +
| -
| -
|
|
* Sputum culture: three successive positive culture for [[Mycobacterium tuberculosis|M. tuberculosis]] confirms the diagnosis.<ref name="pmid12614730">{{cite journal |author=Drobniewski F, Caws M, Gibson A, Young D |title=Modern laboratory diagnosis of tuberculosis |journal=Lancet Infect Dis |volume=3 |issue=3 |pages=141-7 |year=2003 |id=PMID 12614730}}</ref>
* Sputum culture:
* The presence of acid fast bacilli in sputum smear indicates to high extent tuberculosis.
** Three successive positive cultures for ''[[Mycobacterium tuberculosis|M. tuberculosis]]'' confirm the diagnosis<ref name="pmid12614730">{{cite journal |author=Drobniewski F, Caws M, Gibson A, Young D |title=Modern laboratory diagnosis of tuberculosis |journal=Lancet Infect Dis |volume=3 |issue=3 |pages=141-7 |year=2003 |id=PMID 12614730}}</ref>
** Presence of [[Acid-fast|acid fast]] bacilli in [[sputum]] smear indicates tuberculosis
|
|
* Chest X ray is an important diagnostic imaging procedure in TB diagnosis. It shows the following:<ref>{{Cite journal
* Chest X-ray is an important diagnostic imaging procedure in TB diagnosis. X-ray may show:<ref>{{Cite journal
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]]
  | title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
  | title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review
Line 149: Line 165:
  | pmid = 24788998
  | pmid = 24788998
}}</ref>
}}</ref>
** Parenchymal infilration
** Hilar [[adenopathy]]
**[[Nodules]]
**[[Pleural effusion (patient information)|Pleural effusion]]


**Parenchymal infilration
* CT scan may show:<ref>{{Cite journal
**Hilar [[adenopathy]]
**[[Nodules]]
**[[Pleural effusion (patient information)|pleural effusion]]
*CT scan shows the following:<ref>{{Cite journal
  | author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]]
  | author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]]
  | title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging
  | title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging
Line 162: Line 178:
  | doi = 10.1378/chest.14-0196
  | doi = 10.1378/chest.14-0196
  | pmid = 25086249
  | pmid = 25086249
}}</ref>  
}}</ref>
**Micronodules
** Micronodules
**[[Cavitation]]
** [[Cavitation]]
**[[Consolidation (medicine)|Consolidation]]  
** [[Consolidation (medicine)|Consolidation]]
**Interlobular septal thickening  
**Interlobular septal thickening  
* EKG may have abnormalities in case pleural effussion associated with TB.  
*[[EKG]] may show abnormalities in the case of [[pleural effusion]] associated with [[Tuberculosis|TB]]. These abnormalities include:
**[[Low QRS voltage]] 
**[[Electrical alternans]]


|-
|-
|[[Hamman-Rich syndrome|Interstitial pneumonitis]] (Hamman - Rich syndrome)  
|[[Hamman-Rich syndrome|Interstitial pneumonitis]]       ([[Hamman-Rich syndrome|Hamman - Rich syndrome]])  
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
|Productive  
|Productive  
| -
| -
| -
| +
| +
| -
| -
| -
|
|
* Arterial blood gases: [[hypoxemia]] and PaO2/FiO2 less than 200 mmHg which indicates [[acute respiratory distress syndrome]].
* [[Arterial blood gas|Arterial blood gases]] may show:  
* Other lab tests are usually used to exclude other diseases.
** [[Hypoxemia]]  
** [[PaO2]]/[[FiO2]] less than 200 mmHg indicating [[acute respiratory distress syndrome]]
* Other lab tests are done to exclude other diseases  
|
|
* Chest X ray shows bilateral airway opacification.
* [[Chest X-ray]] may show:
* CT scan shows ground glass appearance.
** Bilateral opacification  
* [[Bronchoscopy]] may be performed to exclude other causes like [[alveolar]] [[hemorrhage]] and [[lymphoma]].
* [[CT scan]] may show
* Lung biopsy is a last step in diagnosis of [[Interstitial pneumonitis|acute interstitial pneumonitis]] in order to confirm the disease and exclude other causes of [[Acute respiratory distress syndrome|ARDS]].
** [[Ground glass opacification on CT|Ground glass]] appearance
* [[Bronchoscopy]] to exclude other causes such as:
** [[Alveolar]] [[hemorrhage]]  
** [[Lymphoma]]
* [[Lung]] [[biopsy]] is done:
** In unclear cases; to confirm [[Interstitial pneumonitis|acute interstitial pneumonitis]]  
** Exclude other causes of [[Acute respiratory distress syndrome|ARDS]]
|-
|-
|[[Foreign body aspiration]]
|[[Foreign body aspiration]]
| +
| +
|<nowiki>+</nowiki>
|Bloody
|Bloody
|<nowiki>+</nowiki>
| +
| +
| -
| -
| -
| -
| -
|
|
* Lab tests are performed to evaluate the [[ventilation]] function.
* Lab tests to evaluate the [[ventilation]] function  
|
|
* Chest X ray shows hyperinflation, mediastinal shift and [[atelectasis]].
* [[Chest X-ray]] shows:
** Hyperinflation
** [[Mediastinal]] shift
** [[Atelectasis]]  
|-
|-
|[[Pertussis]]  
|[[Pertussis]]  
| +
| +
|
|Dry
|Dry
|
| -
| -
| -
| -
| -
| -
| -
|
|
* Nasopharyngeal swab for [[Polymerase chain reaction|PCR testing.]]  
* [[Nasopharyngeal]] swab for [[Polymerase chain reaction|PCR testing]]  
* [[Sputum culture]]
* [[Sputum culture]]
* Serology to detect [[pertussis toxin]].<ref name="CDC4">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017]</ref><ref name="CDC3">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017] </ref>
* Serology to detect [[pertussis toxin]]<ref name="CDC4">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017]</ref>
|
|
* No remarkable imaging findings.
* No remarkable imaging findings
|-
|-
|[[Congestive heart failure]]
|[[Congestive heart failure]]
| -
| -
|<nowiki>+ while walking </nowiki>
|Dry/Productive
|Dry/Productive
|<nowiki>+ while walking </nowiki>
| -
| -
| -
| -
| +
| +
| +
|
|
*Routine lab tests in order to know the cause of the [[heart failure]]:
*Routine lab tests to identify the cause of the [[heart failure]]:
**Renal function tests including [[urinalysis]] and [[Electrolyte|electrolytes]] assessment
**[[Renal function tests]] including [[urinalysis]] and [[Electrolyte|electrolytes]]  
**[[Complete blood count]]
**[[Complete blood count]]
**[[Thyroid]] studies specially in patients who are being treated with concomitant therapy with an agent such as [[amiodarone]].
**[[Thyroid]] studies in patients being treated with concomitant therapy such as [[amiodarone]]
*Biomarkers:  
*Biomarkers:  
**Natriuretic Peptides: [[BNP]] or [[NT-proBNP]]<ref name="pmid23747642">{{cite journal |vauthors=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL |title=2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=J. Am. Coll. Cardiol. |volume=62 |issue=16 |pages=e147–239 |year=2013 |pmid=23747642 |doi=10.1016/j.jacc.2013.05.019 |url=}}</ref>
**[[BNP]] or [[NT-proBNP]]<ref name="pmid23747642">{{cite journal |vauthors=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL |title=2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=J. Am. Coll. Cardiol. |volume=62 |issue=16 |pages=e147–239 |year=2013 |pmid=23747642 |doi=10.1016/j.jacc.2013.05.019 |url=}}</ref>
**Biomarkers of myocardial Injury: Cardiac Troponin T or I
**[[Cardiac]] [[troponin T]] or [[Troponin I|I]]
**Carbohydrate Antigen 125<ref name="pmid27810078">{{cite journal| author=D'Aloia A, Vizzardi E, Metra M| title=Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 11 | pages= 844-846 | pmid=27810078 | doi=10.1016/j.jchf.2016.09.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27810078  }} </ref>
**[[CA125|Carbohydrate Antigen 125]]<ref name="pmid27810078">{{cite journal| author=D'Aloia A, Vizzardi E, Metra M| title=Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 11 | pages= 844-846 | pmid=27810078 | doi=10.1016/j.jchf.2016.09.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27810078  }} </ref>
|
|
* EKG can be performed to detect the underlaying cause.
* [[EKG]] to detect underlying cause  
* Chest x ray shows cardiomegaly.
* [[Chest X-ray]] shows [[cardiomegaly]]
* Echocardiography is used to determine the [[stroke volume]] and to assess the heart failure.<ref name="pmid19700135">{{cite journal |vauthors=Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J |title=Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers |journal=J. Card. Fail. |volume=15 |issue=7 |pages=586–92 |year=2009 |pmid=19700135 |doi=10.1016/j.cardfail.2009.03.002 |url=}}</ref>  
* [[Echocardiography]] is done:
** To determine [[stroke volume]]
** To assess type of [[heart failure]]<ref name="pmid19700135">{{cite journal |vauthors=Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J |title=Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers |journal=J. Card. Fail. |volume=15 |issue=7 |pages=586–92 |year=2009 |pmid=19700135 |doi=10.1016/j.cardfail.2009.03.002 |url=}}</ref>
|}
|}


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Latest revision as of 20:43, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Bronchiolitis must be differentiated from other respiratory and cardiac diseases that present with similar clinical manifestations of cough and dyspnea. Bronchiolitis should be differentiated from asthma, COPD, pneumonia, congestive heart failure, diffuse idiopathic neuroendocrine cell hyperplasia, tuberculosis, pertussis, foreign body aspiration, pulmonary embolism, and Harman-Rich syndrome.

Differentiating bronchiolitis from other diseases

Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the similar clinical manifestations like cough and dyspnea. The differentials include the follwoing:[1][2][3][4][5]

Diseases Symptoms Signs Diagosis
Fever Chest pain Cough Wheeze Crackles Tachycardia Lab tests Imaging
Bronchiolitis +/- - Dry + + +/-
Asthma - - Dry/Productive + - -
Chronic obstructive pulmonary disease (COPD) + - Productive + + +
Bacterial pneumonia + + Productive + + +/-
Pulmonary embolism (PE) +/- + Bloody + + +
Diffuse idiopathic neuroendocrine cell hyperplasia[9] - - Dry + - -
Tuberculosis + + Bloody - - -
Interstitial pneumonitis (Hamman - Rich syndrome) + - Productive - + -
Foreign body aspiration + + Bloody + - -
Pertussis + Dry - - -
  • No remarkable imaging findings
Congestive heart failure - + while walking Dry/Productive - - +

References

  1. ↑ Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY; et al. (2016). "[The distribution characteristics of etiology of chronic cough in Lanzhou]". Zhonghua Jie He He Hu Xi Za Zhi. 39 (5): 362–7. doi:10.3760/cma.j.issn.1001-0939.2016.05.006. PMID 27180590.
  2. ↑ Lin L, Chen Z, Cao Y, Sun G (2017). "Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis". Am J Rhinol Allergy. 31 (2): 96–104. doi:10.2500/ajra.2017.31.4418. PMID 28452705.
  3. ↑ Jiang S, Li J, Zeng Q, Liang J (2017). "Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report". Oncol Lett. 13 (4): 2713–2716. doi:10.3892/ol.2017.5775. PMC 5403205. PMID 28454456.
  4. ↑ Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH; et al. (2016). "A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough". Pharmacogenomics J. 16 (3): 231–7. doi:10.1038/tpj.2015.51. PMC 4713364. PMID 26169577.
  5. ↑ Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016
  6. ↑ Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM; et al. (2008). "An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients". Respir Med. 102 (6): 825–30. doi:10.1016/j.rmed.2008.01.016. PMID 18339530.
  7. ↑ Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M (2013). "Analysis of electrocardiogram in chronic obstructive pulmonary disease patients". Med Pregl. 66 (3–4): 126–9. PMID 23653989.
  8. ↑ Cvitanic O, Marino PL (1989). "Improved use of arterial blood gas analysis in suspected pulmonary embolism". Chest. 95 (1): 48–51. PMID 2491801. Retrieved 2012-04-30. Unknown parameter |month= ignored (help)
  9. ↑ Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F (2011). "Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview". Am J Respir Crit Care Med. 184 (1): 8–16. doi:10.1164/rccm.201010-1685PP. PMID 21471097.
  10. ↑ Drobniewski F, Caws M, Gibson A, Young D (2003). "Modern laboratory diagnosis of tuberculosis". Lancet Infect Dis. 3 (3): 141–7. PMID 12614730.
  11. ↑ Riccardo Piccazzo, Francesco Paparo & Giacomo Garlaschi (2014). "Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review". The Journal of rheumatology. Supplement. 91: 32–40. doi:10.3899/jrheum.140100. PMID 24788998. Unknown parameter |month= ignored (help)
  12. ↑ Jeong Min Ko, Hyun Jin Park & Chi Hong Kim (2014). "Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging". Chest. doi:10.1378/chest.14-0196. PMID 25086249. Unknown parameter |month= ignored (help)
  13. ↑ Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017
  14. ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 62 (16): e147–239. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  15. ↑ D'Aloia A, Vizzardi E, Metra M (2016). "Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial". JACC Heart Fail. 4 (11): 844–846. doi:10.1016/j.jchf.2016.09.001. PMID 27810078.
  16. ↑ Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J (2009). "Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers". J. Card. Fail. 15 (7): 586–92. doi:10.1016/j.cardfail.2009.03.002. PMID 19700135.

References

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